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Influence of language barriers on outcomes of hospital care for general medicine inpatients

Authors

  • Leah S. Karliner MD, MAS,

    Corresponding author
    1. Department of Medicine, University of California at San Francisco, San Francisco, California
    2. Medical Effectiveness Research Center for Diverse Populations, Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
    • UCSF Mt. Zion, 1701 Divisidero St. Suite 500, San Francisco, CA 94143-1732
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    • Telephone: 415-885-7893; Fax: 415-353-7932

  • Sue E. Kim PhD, MPH,

    1. Department of Medicine, University of California at San Francisco, San Francisco, California
    2. Medical Effectiveness Research Center for Diverse Populations, Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
    3. Health and Barriers to Employment, Department of MDRC, California Office, Oakland, California
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  • David O. Meltzer MD, PhD,

    1. Department of Medicine, The Harris School for Public Policy and the Department of Economics, University of Chicago, Chicago, Illinois
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  • Andrew D. Auerbach MD, MPH

    1. Department of Medicine, University of California at San Francisco, San Francisco, California
    2. Division of Hospital Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
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  • This research was supported by a grant from the University of California, San Francisco Medical Center (UCSF) Academic Senate Research Evaluation and Allocation Committee. The Multicenter Hospitalist Study was supported by grant R01 HS10597 AHRQ from the Agency for Healthcare Research and Quality, and was registered at Clinicaltrials.gov: NCT00204048. Dr. Karliner is supported by a Mentored Research Scholar Grant (MRSG-060253-01) from the American Cancer Society. Dr. Auerbach is supported by a K08 research and training grant (K08 HS11416-02) from the Agency for Healthcare Research and Quality.

  • The authors are unaware of any conflict of interest related to this study.

Abstract

BACKGROUND:

Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency.

OBJECTIVE:

To examine whether patients' primary language influences hospital outcomes.

DESIGN AND SETTING:

Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003.

PATIENTS:

Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese.

MEASUREMENTS:

Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality.

RESULTS:

Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non-English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively).

CONCLUSIONS:

After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. © 2010 Society of Hospital Medicine.

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